Tertiary Health Centre In Nigeria Research Articles

Sickle cell anaemia: Morbidity profile and outcome in a paediatric emergency setting in Nigeria

Background: Sickle Cell Anemia (SCA) is an inherited disorder which is associated with significant morbidity and mortality. Early recognition as well as prompt and effective management of the morbidities seen in SCA is key to the survival of patients with the disease. Objective: To determine the morbidity profile and outcome of patients with sickle cell anemia (SCA) admitted into an Emergency Pediatric Unit (EPU) of a tertiary health center in Nigeria. Methods: A retrospective study in which records of admissions of children with SCA over a two-year period (June 2011 to May 2013) were obtained from the EPU records. Information retrieved included age, sex, diagnosis and outcome as far as the unit is concerned. Results: One hundred and forty-seven children, 11.9% of the total (1,234 patients) EPU admission, aged between six months and 18 years (mean age being 84.76 ± 57.24 months) were studied. Male: female ratio was 1.3: 1. Vaso-occlusive (53.2%), hyper-hemolytic (37.6%) and acute sequestration crises (9.2%) were noted but no case of aplastic crisis was seen. Among infections, Malaria (56.2%), Sepsis (15.6%) and pneumonia (12.5%) were the major cases documented. Two (50-0%) patients died of acute sequestration crisis, one (25.0%) of meningitis and another (25.0%) of hyper-hemolytic crisis with severe anemia. Mortality rate was 2.7%. Conclusion/ Recommendation: SCA admissions in our EPU are mainly due to vaso-occlusive crises and infections. Acute sequestration crisis was the leading cause of death followed by meningitis and hyper-hemolytic crisis. Prompt and effective transfusion services, the use of pneumococcal conjugate vaccine as well as judicious use of appropriate antibiotics will augment the chances of survival in these children.

Association of hypertension and obesity with HIV and antiretroviral therapy in a rural tertiary health center in Nigeria: a cross-sectional cohort study

BackgroundThere are few studies from Nigeria and Africa regarding the contribution of obesity and hypertension to cardiovascular risk in HIV-infected patients. This study investigates the prevalence of hypertension and obesity and their association with HIV infection and antiretroviral treatment (ART).MethodsWe conducted a cross-sectional cohort study in a rural tertiary health center in Nigeria. The data collected included demographic variables, blood pressure, body mass index (BMI), monthly income, educational attainment, HIV status and ART treatment, duration of treatment, and CD4 T-lymphocyte count.ResultsA total of 403 participants met the inclusion criteria. There were 153 (38.0%) HIV-negative subjects (42.5% male, 57.5% female; mean age: 35.5±7.6 years), 120 (29.8%) HIV-positive drug-naïve subjects (42.5% male, 57.5% female; mean age: 36.5±9.1 years), and 130 (32.2%) HIV-positive subjects taking antiretroviral drugs (33.1% male, 66.9% female; mean age: 38.6±8.0 years). The prevalence of hypertension was 13.7% in HIV-negative subjects, 19.0% in HIV-positive drug-naïve subjects, and 12.3% in HIV-positive ART subjects. The prevalence of obesity was 15.9% in the HIV-negative group, 3% in the HIV-positive drug-naïve group, and 8% in the HIV-positive ART group. Multivariate regression analysis showed no relationship between hypertension and HIV status (P=0.293) or ART status (P=0.587). In contrast, BMI showed a strong relationship with HIV status (odds ratio: 0.281; 95% confidence interval: 0.089–0.884; P=0.030) but not with ART status (P=0.593). BMI was a significant predictor of hypertension.ConclusionHIV or ART status was not associated with hypertension. HIV infection was associated with a lower BMI, and a lower prevalence of obesity compared with HIV-negative subjects.

Circumcision: Perspective in a Nigerian teaching hospital

The practice and pattern of male infants circumcised is influenced by culture, religion and socio-economic classification. The debate about the benefits and risks of circumcision has made a hospital-based practice the most acceptable. The objective of this study is to evaluate the ages, indications, co-morbidity, types and methods of circumcision, usage and mode of anaesthesia and outcome of male circumcision at a tertiary health centre in Nigeria. A retrospective review of male circumcision in a paediatric surgery unit was done from January 2002 to December 2007. The data was analysed using SPSS software version 15. There were 438 boys with age ranged between 6 days and 10 years (median 28 days, mean 53.6 days standard deviation 74.2). Neonatal circumcision (<29 days) was 201 (46%) and 318 (72.6%) of the children were circumcised by the 3 rd month of live. Religion or tradition were the major indicators in 384 (87.7%) patients while phimosis 38 (8.7%), paraphimosis 4 (1%), redundant post circumcision skin 10 (2.3%) and defective prepuce in 2 (0.5%) were other indications. Plastibel™ (PD) was used in 214 (48.9%), classical circumcision 194 (44.2%), guillotine technique (GT) and Gomco™ 10 (2.3%) cases each while 10 (2.3%) had a refashioning/re-excision post previous circumcision. There was an increase in use of PD, drop in the use of GT; and increase in the number of circumcision done over the years. Only 39.7% had anaesthesia administered and complication rate was 6.7%. Neonatal circumcision was highest in the hospital-based circumcision practice, which allowed the expected ideals in the use of devices in a tertiary health centre. However, the low rate of anaesthetic use is unacceptable.

Incidence of hepatotoxicity of highly active Antiretroviral Therapy in a Tertiary Health Centre in Nigeria.

The aim of this study was to determine the incidence of hepatotoxicity of HAART in HIV infected patients in a tertiary health centre in Nigeria. This study was carried out on HIV patients on HAART attending infectious disease clinic, gastroenterology clinic or admitted into the medical wards of University of Benin Teaching Hospital. HAART-naive HIV patients were used as controls. A clinical evaluation and relevant laboratory investigations were done. Hepatotoxicity was defined using a standardised toxicity grade scale. A total of 84 cases and 42 controls were studied. The mean ages were 35.2± 9.9years and 35.5±9.0 years for the cases and the controls respectively. Over 70% of the study population and controls were females. The overall incidence of hepatotoxicity was 17.9% and severe hepatotoxicity occurred in 10.7% of the patients. Alcohol use and being underweight were independent risk factors for hepatotoxicity. This prospective study clearly shows that there was appreciable hepatotoxicity associated with HAART in the study patients as found in other parts of the world. There is a need for regular monitoring of liver function in these patients because of the risk of hepatotoxicity.

The challenges of managing malignant head and neck tumors in a tropical tertiary health center in Nigeria

The challenges of managing malignant head and neck tumors in a tropical tertiary health center in Nigeria

Trends in the Pattern of Leukaemia Incidence in a Tertiary Health Center in Nigeria: 1990-2004

Leukaemia is an important cause of morbidity and mortality in Nigeria. The aim of this study is to determine the incidence and trend in the pattern of adult leukaemia over a period of 15 years in Benin City, Nigeria. The case records of 253 cases that attended the University of Benin Teaching Hospital, Benin City, Nigeria from 1990-2004 with a diagnosis of leukaemia were analyzed. Chronic myeloid leukaemia (CML) was the more frequent variety (27.7%), followed by chronic lymphocytic leukaemia (CLL) and prolymphocytic leukaemia (PLL) with equal proportions of 21.3% each. Time trend analysis by 5-year calendar periods revealed an increasing number and incidence of patients with leukaemia. There was also an increased incidence of leukaemia among the youths (21-40years) whereas that of the older patients (61-70years) has decreased. There was a statistically significant association between age and number of leukaemia cases at presentation for the various years (P = 0.023). A positive correlation with a significant linear trend was also obtained (r = 0.3507; P = 0.0048) such that there was a predominance of young patients (21-40 years) in latter years (2000-2004) compared to a decline in the older patients (> 60 years) for the period studied. There was increased incidence of leukaemia especially among the younger age groups. Keywords : Leukaemia; trend; pattern; incidence Journal of Medicine and Biomedical Research Vol. 5 (2) 2006: pp. 44-49

Prevalence and Predictors of White Coat Hypertension among Newly-Diagnosed Hypertensive Patients in a Tertiary Health Centre in Nigeria.

Failure to diagnose and adequately classify newly-diagnosed hypertensive patients may lead to non-recognition of White Coat Hypertension (WCH) and inappropriate use of antihypertensive medications. This study determined the prevalence and predictors of white coat hypertension among newly-diagnosed hypertensive patients in a tertiary health centre in Nigeria. One hundred and twenty newly-diagnosed hypertensive patients and 120 controls were recruited for the study. All the participants had 24-hour Ambulatory Blood Pressure Monitoring (ABPM) using an oscillometric device (CONTEC®). Data were analyzed using SPSS version 20.0. Out of 120 patients, 52 were males and the mean age was 44.2 ± 9.7 years whereas of the 120 controls, 53 were males and the mean age was 44.0 ± 7.5 years. The mean body mass index of the patients, BMI (27.0 ± 4.5kg/m2) was higher than control (24.1 ± 4.5kg/m2), p-value <0.001. The prevalence of WCH was 36.7%. The mean age and BMI of those with WCH were 43.3 ± 11.4 years and 26.4 ± 4.5kg/m2 respectively. Females constituted a greater proportion (70.5%). In multivariate analysis, high level of education and being overweight or obese were significant determinants of WCH. High prevalence of WCH existed among participants studied. High level of education and being obese were predictors of white coat hypertension. Hence, ambulatory blood pressure monitoring should be included as part of routine work-up for newly-diagnosed hypertensive patients in order to limit the number of those who may be committed to lifelong antihypertensive medications with its unwanted side effects.